Dear Tom,
Thanks for your email and sorry for my delay in replying. Any insight into how other LPAs approach situations like this is greatly appreciated.
I understand how one's personal opinion can be at odds with the stricter interpretation of the law. I take on board that the goggles aren't comfortable, I've worn them myself though not for as long as the surgeons must and this is the very issue that the urologist working here has which prompted him to email me the link to the paper I quoted. Apologies, I seem to have missed that in my original email and I do indeed sympathise with the surgeon.
Long story short, I've decided to continue recommending the wearing of laser safety goggles (for now at least). Thank you as well to those of you who replied off list, your views were welcome too.
Kind regards,
Clare.
-----Original Message-----
From: British Medical Laser Association [mailto:[log in to unmask]] On Behalf Of Tom Lister
Sent: 01 September 2016 10:46
To: [log in to unmask]
Subject: Re: Recent paper questioning need for laser safety goggles in endourology
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Dear Clare,
Thank you for highlighting this paper and the issue that I am sure many are familiar with regarding the use of eye protection in endourology.
I currently recommend the use of laser safety goggles for our surgeons in Salisbury. However, I personally think that the probability of an accidental eye strike is very low, and the likely consequence in any realistic situation is minimal. The problem is that the evidence is not strong (including this paper, as you point out), so I feel that there is too much uncertainty to base a change of practice upon.
I have worn these glasses for an extended period during a HOLAP procedure and they did become uncomfortable on the bridge of my nose, due to their weight. I could imagine an entire day list would be quite unpleasant, especially where a surgeon is scrubbed up and can't move the goggles for comfort during procedures. I noticed that one of our surgeons taped his hairnet to his goggles to reduce the weight on his nose. Although lighter (plastic) safety goggles are available, they do not offer a very high 'LB number'.
Due to this discomfort, I disagree with your point that the risk is 'easily mitigated by wearing safety glasses', which I think changes the argument for/against the use of goggles.
Overall, I feel that I cannot prove that the risk of harm is high enough to warrant wearing goggles. However, my understanding is that there is a risk of eye exposure over the MPE, and therefore eye protection should be recommended to comply with artificial optical radiations regs.
I would be very interested to get a feel for the consensus opinion on this issue amongst UK LPAs.
Best wishes,
Tom
-----Original Message-----
From: British Medical Laser Association [mailto:[log in to unmask]] On Behalf Of Joy, Clare
Sent: 31 August 2016 14:15
To: [log in to unmask]
Subject: Recent paper questioning need for laser safety goggles in endourology
Dear List,
A urologist working in my Trust has pointed me in the direction of a recently published paper as to why he thinks his eyeglasses are sufficient for laser safety when using a Ho:YAG machine: "Do We Really Need to Wear Proper Eye Protection When Using Holmium:YAG Laser During Endourologic Procedures? Results from an Ex Vivo Animal Model on Pig Eyes" at http://online.liebertpub.com/doi/10.1089/end.2015.0232. Given that it was only published this year maybe you haven't already come across it but if you have I'd be very interested in having a chat about how you approached the thorny issue of surgeons not wanting to wear laser safe eyewear.
The paper shows that no ill effects were found in unprotected eyes at distances greater than 8cm from the laser set at its maximum setting of 2J at 10Hz. It also shows that no effects were shown at any distance in eyes protected by eyeglasses and laser safety goggles using their setup.
Upon reading the paper a few things came to mind:
1. The exposure time used was 1s as this was deemed reproducible with some discussion about how the blink reflex would shorten the exposure time in a real life accidental exposure situation. My problem with this is that the wavelength is not visible therefore using the blink reflex as a limiting factor seems flawed and I'm used to using a 10s exposure for invisible lasers. They do provide a table where they used a worst case scenario of 2J at 10Hz for 5s though.
2. The paper does not provide the divergence of the beam which would have been nice to know and compare with the laser we have here. It also doesn't state a NOHD but I would assume it's 1-2m.
2. The authors used dead pig eyes rather than live pig eyes and admit that further testing is required to see how live eyes would respond.
3. The paper's very last sentence recommends "the use of laser safety glasses or at least eyeglasses" even though "the risk of eye injury is minimal". So I find myself thinking (again) that the risk may be small but it is real and easily mitigated by wearing safety glasses so my position remains unchanged after reading the paper and advise that laser safety glasses are worn by everyone in the room. And that's without even considering fibre breakage and laser radiation being emitted from an unexpected location mid operation or that the output may be greater than the setting in the event of machine fault.
I would welcome your thoughts and feel free to reply on or off list.
Kind regards,
Clare.
Clare Joy | Principal Clinical Scientist | Lead for Non-Ionising Radiation Protection Radiation Protection, Medical Physics Department, MP 29, Southampton General Hospital Tremona Road, Southampton, SO16 6YD
T: 023 8120 4947
E: [log in to unmask]
W: www.uhs.nhs.uk
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